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Tang MT, Chui PL, Chong MC, Zhang HY, Li XM, Wang T. Translation, cross-cultural adaptation, reliability, and validity of the Chinese version of the intensive care unit environment stress scale for pediatric patients. J Pediatr Nurs 2024; 77:e511-e519. [PMID: 38782669 DOI: 10.1016/j.pedn.2024.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 05/07/2024] [Accepted: 05/08/2024] [Indexed: 05/25/2024]
Abstract
PURPOSE There is currently a lack of understanding of children's experience in the pediatric intensive care unit (PICU) environment. Additionally, pediatric patients may experience post-PICU syndrome following discharge. Thus, we aimed to adapt and evaluate the psychometric properties of a tool specifically for use with children in the PICU. DESIGN AND METHODS According to Brislin's Model, the Intensive Care Unit Environment Stress Scale (ICUESS) was translated both forward and backward and adapted cross-culturally. A total of 210 PICU patients were selected from four hospitals in XXX to analyze the final translated version of the questionnaire, the Pediatric Intensive Care Unit Environmental Stress Scale (PICUESS). Content validity, exploratory factor analysis (EFA) and Confirmatory Factor Analysis (CFA) were used to assess the validity, while reliability was assessed using Cronbach's alpha and split-half reliability analysis. RESULTS For PICUESS, seven of 42 items were modified. Content validity was high (overall = 0.96, item validity = 0.8 to 1.0). Exploratory factor analysis revealed eight common factors (Kaiser-Meyer-Olkin = 0.857, significant Bartlett's test). The results of the CFA indicate that the scale model fits well across the 8 factors. The entire scale demonstrated excellent internal consistency (Cronbach's alpha = 0.934). The overall split-half reliability was 0.935. CONCLUSIONS The Chinese version of PICUESS demonstrates good reliability and validity, making it suitable for assessing pediatric patients' perceptions of the PICU environment. PRACTICE IMPLICATIONS The PICUESS can assist healthcare professionals in providing personalized environment care for PICU patients. It has the potential to serve as a tool for further testing and international comparisons of pediatric patients' perceptions of the PICU environment.
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Affiliation(s)
- Mao Ting Tang
- Department of Nursing Science, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia; Department of Pediatric Intensive Care Unit Nursing, West China Second University Hospital, Sichuan University, West China School of Nursing, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Chengdu, Sichuan, China
| | - Ping Lei Chui
- Department of Nursing Science, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia.
| | - Mei Chan Chong
- Department of Nursing Science, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia
| | - Hai Yang Zhang
- Department of Pediatric Intensive Care Unit Nursing, West China Second University Hospital, Sichuan University, West China School of Nursing, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Chengdu, Sichuan, China
| | - Xiao Min Li
- Department of Nursing Science, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia
| | - Ting Wang
- Department of Pediatric Intensive Care Unit Nursing, West China Second University Hospital, Sichuan University, West China School of Nursing, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Chengdu, Sichuan, China
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Gonzalez-Baz MD, Pacheco Del Cerro E, Ferrer-Ferrándiz E, Araque-Criado I, Merchán-Arjona R, de la Rubia Gonzalez T, Moro Tejedor MN. Psychometric validation of the Kolcaba General Comfort Questionnaire in critically ill patients. Aust Crit Care 2023; 36:1025-1034. [PMID: 36906429 DOI: 10.1016/j.aucc.2022.12.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 12/14/2022] [Accepted: 12/23/2022] [Indexed: 03/12/2023] Open
Abstract
BACKGROUND There is a lack of validated tools to measure comfort in critically ill patients. OBJECTIVE The objective of this study was to evaluate the psychometric properties of the General Comfort Questionnaire (GCQ) in patients admitted to intensive care units (ICUs). METHODOLOGY A total of 580 patients were recruited, randomising the sample into two homogeneous subgroups of 290 patients for exploratory factor analysis and confirmatory factor analysis, respectively. The GCQ was used to assess patient comfort. Reliability, structural validity, and criterion validity were analysed. RESULTS The final version included 28 of the 48 items from the original version of the GCQ. This tool was named the Comfort Questionnaire (CQ)-ICU, maintaining all types and contexts of the Kolcaba theory. The resulting factorial structure included seven factors: psychological context, need for information, physical context, sociocultural context, emotional support, spirituality, and environmental context. A Kaiser-Meyer-Olkin value of 0.785 was obtained, with Bartlett's sphericity test (0.000) being significant, and the total variance explained was 49.750%. The Cronbach's alpha was 0.807, with subscale values ranging from 0.788 to 0.418. Regarding convergent validity, high positive correlations were obtained between the factors and the GCQ score, the CQ-ICU score, and the criterion item GCQ31: "I am content". In terms of divergent validity, correlations were low with the APACHE II scale and with the NRS-O except for physical context (-0.267). CONCLUSION The Spanish version of the CQ-ICU is a valid and reliable tool to assess comfort in an ICU population 24 h after admission. Although the resulting multidimensional structure does not replicate the Kolcaba Comfort Model, all types and contexts of the Kolcaba theory are included. Therefore, this tool enables an individualised and holistic evaluation of comfort needs.
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Affiliation(s)
- Ma Dolores Gonzalez-Baz
- Department of Evidence Based Practice, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Department of Nursing, Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Spain.
| | - Enrique Pacheco Del Cerro
- Department of Nursing, Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, Spain; Nursing Management, San Carlos Clinical Hospital, Madrid, Spain.
| | - Esperanza Ferrer-Ferrándiz
- Escuela Universitaria de Enfermería La Fe, Valencia, Spain; Grupo Investigación Arte y Ciencia del Cuidado (GREIAC) of Instituto de Investigación Sanitaria La Fe, Spain.
| | - Irene Araque-Criado
- Department of Evidence Based Practice, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
| | - Raúl Merchán-Arjona
- Escuela de Enfermería de Cruz Roja Española, Universidad Autónoma de, Madrid, Spain.
| | | | - Ma Nieves Moro Tejedor
- Nursing Research Support Unit, Hospital General Universitario Gregorio Marañon, Madrid, Spain; Red Cross University College of Nursing, Spanish Red Cross, Autonomous University of Madrid, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Spain.
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Ford DM, Budworth L, Lawton R, Teale EA, O’Connor DB. In-hospital stress and patient outcomes: A systematic review and meta-analysis. PLoS One 2023; 18:e0282789. [PMID: 36893099 PMCID: PMC9997980 DOI: 10.1371/journal.pone.0282789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 02/18/2023] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND Hospital inpatients are exposed to high levels of stress during hospitalisation that may increase susceptibility to major adverse health events post-hospitalisation (known as post-hospital syndrome). However, the existing evidence base has not been reviewed and the magnitude of this relationship remains unknown. Therefore, the aim of the current systematic review and meta-analysis was to: 1) synthesise existing evidence and to determine the strength of the relationship between in-hospital stress and patient outcomes, and 2) determine if this relationship differs between (i) in-hospital vs post-hospital outcomes, and (ii) subjective vs objective outcome measures. METHODS A systematic search of MEDLINE, EMBASE, PsychINFO, CINAHL, and Web of Science from inception to February 2023 was conducted. Included studies reported a measure of perceived and appraised stress while in hospital, and at least one patient outcome. A random-effects model was generated to pool correlations (Pearson's r), followed by sub-group and sensitivity analyses. The study protocol was preregistered on PROSPERO (CRD42021237017). RESULTS A total of 10 studies, comprising 16 effects and 1,832 patients, satisfied the eligibility criteria and were included. A small-to-medium association was found: as in-hospital stress increased, patient outcomes deteriorated (r = 0.19; 95% CI: 0.12-0.26; I2 = 63.6; p < 0.001). This association was significantly stronger for (i) in-hospital versus post-hospital outcomes, and (ii) subjective versus objective outcome measures. Sensitivity analyses indicated that our findings were robust. CONCLUSIONS Higher levels of psychological stress experienced by hospital inpatients are associated with poorer patient outcomes. However, more high-quality, larger scale studies are required to better understand the association between in-hospital stressors and adverse outcomes.
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Affiliation(s)
- Daniel M. Ford
- School of Psychology, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom
- Quality and Safety Research Group, Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, United Kingdom
- * E-mail:
| | - Luke Budworth
- NIHR Applied Research Collaboration Yorkshire and Humber, Bradford, United Kingdom
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom
| | - Rebecca Lawton
- School of Psychology, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom
- Quality and Safety Research Group, Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, United Kingdom
| | - Elizabeth A. Teale
- Academic Unit for Aging and Stroke Research, University of Leeds, Leeds, United Kingdom
| | - Daryl B. O’Connor
- School of Psychology, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom
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Bulbuloglu S, Çınar F, Çürük GN. The Effect of Environmental Stressors on Patient Experience in Medical, Surgical, and COVID-19 Intensive Care Unit. J Patient Exp 2022; 9:23743735221092545. [PMID: 35434297 PMCID: PMC9008315 DOI: 10.1177/23743735221092545] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
This study was conducted to evaluate the effects of environmental stressors on
patients’ intensive care experiences in medical, surgical, and COVID-19
intensive care units (ICUs). The sample group consisted of 231 patients
hospitalized in medical and surgical ICUs and agreed to participate in the
study. The data analysis was performed with IBM SPSS Statistics 25. The average
age of the patients was 53.67 ± 13.3, 55.4% were male, 47.6% were high school
graduates, and 45.5% were followed up in the COVID-19 ICU. It was also found
that there was a negative and moderate degree of correlation between the
Intensive Care Experience Scale (ICES) and the Intensive Care Unit Environmental
Stressors Scale (ICUESS). Environmental stressors in ICUs are associated with
patient experiences. It is clear that ICU stressors create a negative perception
in the patient and this situation is emotionally exhausting.
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Affiliation(s)
- Semra Bulbuloglu
- Surgical Nursing Division, Nursing Department, Faculty of Health Sciences, Istanbul Aydin University, Istanbul, Turkey
| | - Fadime Çınar
- Surgical Nursing Division, Nursing Department, Health Sciences High School, Istanbul Nisantasi University, Istanbul, Turkey
| | - Gülsüm Nihal Çürük
- Internal Medicine Nursing Division, Nursing Department, Health Sciences Faculty, Izmir Ekonomi University, Izmir, Turkey
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Transcultural adaptation and validity of a pictogram to assess communication needs in adults with artificial airway in intensive care. ENFERMERIA INTENSIVA 2021; 32:198-206. [PMID: 34764072 DOI: 10.1016/j.enfie.2021.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 01/11/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To perform the cross-cultural adaptation and validity of a pictogram to assess communication needs in adults with artificial airway in ICU in Cartagena, Colombia. METHOD Scale validation study, population comprising all the patients who were hospitalized in six ICU of Cartagena-Colombia. The sample was made up of 181 adult patients with artificial airway, the adaptation to Spanish was determined (translation, backtranslation, expert review, pre-final version, pilot test, final version), facial validity by expert agreement, content validity with the Lawshe index modified by Tristan (cut-off point 0.58), exploratory factor analysis (AFE) with the Bartlett's test of sphericity and Cattell's graph; internal consistency measured through the Cronbach alpha statistic. RESULTS Patients between the ages of 19 and 88 years participated (mean = 54 ± 17), 91.71% expressed frequent needs for accompaniment, knowing date and time; 61% of the experts agreed with the cross-culturally adapted items, the overall Content Validity Index (CVI) was 0.86 with agreement in understanding eleven items. The AFE suggested retaining 13 items and 3 factors (perception/cognition, elimination and exchange, comfort), which explain the construct. The internal alpha Cronbach consistency was 0.64. CONCLUSIONS The pictographic material, Spanish version, was shown to be a multidimensional instrument composed of 18 items grouped in 3 factors. Therefore, it is recommended it be applied to the patient with artificial airway and to establish communication as a preliminary point of care in nursing.
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Krampe H, Denke C, Gülden J, Mauersberger VM, Ehlen L, Schönthaler E, Wunderlich MM, Lütz A, Balzer F, Weiss B, Spies CD. Perceived Severity of Stressors in the Intensive Care Unit: A Systematic Review and Semi-Quantitative Analysis of the Literature on the Perspectives of Patients, Health Care Providers and Relatives. J Clin Med 2021; 10:jcm10173928. [PMID: 34501376 PMCID: PMC8432195 DOI: 10.3390/jcm10173928] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 08/27/2021] [Accepted: 08/28/2021] [Indexed: 11/16/2022] Open
Abstract
The aim of this study was to synthesize quantitative research that identified ranking lists of the most severe stressors of patients in the intensive care unit, as perceived by patients, relatives, and health care professionals (HCP). We conducted a systematic literature search in PubMed, MEDLINE, EMBASE, PsycInfo, CINAHL, and Cochrane Library from 1989 to 15 May 2020. Data were analyzed with descriptive and semi-quantitative methods to yield summarizing ranking lists of the most severe stressors. We synthesized the results of 42 prospective cross-sectional observational studies from different international regions. All investigations had assessed patient ratings. Thirteen studies also measured HCP ratings, and four studies included ratings of relatives. Data indicated that patients rate the severity of stressors lower than HCPs and relatives do. Out of all ranking lists, we extracted 137 stressor items that were most frequently ranked among the most severe stressors. After allocation to four domains, a group of clinical ICU experts sorted these stressors with good to excellent agreement according to their stress levels. Our results may contribute to improve HCPs' and relatives' understanding of patients' perceptions of stressors in the ICU. The synthesized stressor rankings can be used for the development of new assessment instruments of stressors.
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Affiliation(s)
- Henning Krampe
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 13353 Berlin, Germany; (H.K.); (C.D.); (J.G.); (V.-M.M.); (L.E.); (A.L.); (B.W.)
| | - Claudia Denke
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 13353 Berlin, Germany; (H.K.); (C.D.); (J.G.); (V.-M.M.); (L.E.); (A.L.); (B.W.)
| | - Jakob Gülden
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 13353 Berlin, Germany; (H.K.); (C.D.); (J.G.); (V.-M.M.); (L.E.); (A.L.); (B.W.)
| | - Vivian-Marie Mauersberger
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 13353 Berlin, Germany; (H.K.); (C.D.); (J.G.); (V.-M.M.); (L.E.); (A.L.); (B.W.)
| | - Lukas Ehlen
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 13353 Berlin, Germany; (H.K.); (C.D.); (J.G.); (V.-M.M.); (L.E.); (A.L.); (B.W.)
| | | | - Maximilian Markus Wunderlich
- Institute of Medical Informatics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10117 Berlin, Germany; (M.M.W.); (F.B.)
| | - Alawi Lütz
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 13353 Berlin, Germany; (H.K.); (C.D.); (J.G.); (V.-M.M.); (L.E.); (A.L.); (B.W.)
- Department of Healthcare Management, Technische Universität Berlin, 10623 Berlin, Germany
| | - Felix Balzer
- Institute of Medical Informatics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10117 Berlin, Germany; (M.M.W.); (F.B.)
| | - Björn Weiss
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 13353 Berlin, Germany; (H.K.); (C.D.); (J.G.); (V.-M.M.); (L.E.); (A.L.); (B.W.)
| | - Claudia D. Spies
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 13353 Berlin, Germany; (H.K.); (C.D.); (J.G.); (V.-M.M.); (L.E.); (A.L.); (B.W.)
- Correspondence: ; Tel.: +49-30-450-551-102
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Coelho AC, Santos VB, de Barros ALBL. Stressors in intensive cardiac care units: Patients' perceptions. Nurs Crit Care 2021; 27:195-203. [PMID: 33949036 DOI: 10.1111/nicc.12641] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 04/15/2021] [Accepted: 04/16/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Patients with acute coronary syndrome (ACS) are often admitted to intensive cardiac care units (ICCUs) to have their vital signs and ventricular function monitored. In most cases, they are conscious and bedbound, causing high stress and anxiety levels. AIMS AND OBJECTIVES To assess the stressors affecting patients admitted to ICCUs. DESIGN This is a cross-sectional study performed in a public hospital in São Paulo, Brazil. METHODS A sample of 100 patients with ACS admitted to an ICCU, after 24 hours of hospitalization, was recruited. Sociodemographic and clinical data were collected, and the Intensive Care Unit Stressor Assessment Scale (ICESS) was applied to investigate stressors. The ICESS' internal consistency was estimated by Cronbach's alpha, and the stressors were analysed by descriptive statistics, association tests, and correlation tests. RESULTS Most patients were male, married, and aged 51 to 60 years. The ICESS showed an excellent internal consistency. The mean score identified in patients pointed to a non-stressed to moderately stressed condition. The indicators considered to be more stressful were as follows: "Not knowing ICU length of stay," "Being unable to fulfil family roles," "Missing husband or wife," and "Loss of self-control." CONCLUSIONS Stress levels were considered to be non-stressful to moderately stressful. The main stressors were related to psychological distress and physical discomfort dimensions. RELEVANCE TO CLINICAL PRACTICE Mapping the main stressors of patients with coronary artery disease will allow health professionals to implement strategies to reduce them and consequently reduce their anxiety levels.
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Affiliation(s)
- Aluê Constantino Coelho
- Department of Clinical and Surgical Nursing, Paulista Nursing School, Federal University of São Paulo-UNIFESP, São Paulo, Brazil
| | - Vinicius Batista Santos
- Department of Clinical and Surgical Nursing, Paulista Nursing School, Federal University of São Paulo-UNIFESP, São Paulo, Brazil
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Manrique-Anaya Y, Cogollo Milanés Z, Simancas Pallares M. Transcultural adaptation and validity of a pictogram to assess communication needs in adults with artificial airway in intensive care. ENFERMERIA INTENSIVA 2021; 32:S1130-2399(21)00001-8. [PMID: 33663911 DOI: 10.1016/j.enfi.2021.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 12/17/2020] [Accepted: 01/11/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To perform the cross-cultural adaptation and validity of a pictogram to assess communication needs in adults with artificial airway in ICU in Cartagena, Colombia. METHOD Scale validation study, population comprising all the patients who were hospitalized in six ICU of Cartagena-Colombia. The sample was made up of 181 adult patients with artificial airway, the adaptation to Spanish was determined (translation, backtranslation, expert review, pre-final version, pilot test, final version), facial validity by expert agreement, content validity with the Lawshe index modified by Tristan (cut-off point 0.58), exploratory factor analysis (AFE) with the Bartlett's test of sphericity and Cattell's graph; internal consistency measured through the Cronbach alpha statistic. RESULTS Patients between the ages of 19 and 88years participated (mean: 54±17); 91.71% expressed frequent needs for accompaniment, knowing date and time; 61% of the experts agreed with the cross-culturally adapted items, the overall Content Validity Index (CVI) was 0.86 with agreement in understanding eleven items. The AFE suggested retaining 13 items and 3 factors (perception/cognition, elimination and exchange, comfort), which explain the construct. The internal alpha Cronbach consistency was 0.64. CONCLUSIONS The pictographic material, Spanish version, was shown to be a multidimensional instrument composed of 18 items grouped in 3 factors. Therefore, it is recommended it be applied to the patient with artificial airway and to establish communication as a preliminary point of care in nursing.
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Affiliation(s)
| | | | - M Simancas Pallares
- Division of Pediatric and Public Health, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, Estados Unidos
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Kusi-Appiah E, Karanikola M, Pant U, Meghani S, Kennedy M, Papathanassoglou E. Tools for assessment of acute psychological distress in critical illness: A scoping review. Aust Crit Care 2021; 34:460-472. [PMID: 33648818 DOI: 10.1016/j.aucc.2020.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 11/23/2020] [Accepted: 12/13/2020] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVES Patients' experience of psychological distress in the intensive care unit (ICU) is associated with adverse effects, reduced satisfaction, and delayed physical and psychological recovery. There are no specific guidelines for the assessment and management of acute psychological distress during hospitalisation in the ICU. We reviewed existing tools for the assessment of acute psychological distress in ICU patients, examined evidence on their metric properties, and identified potential gaps and methodological considerations. METHOD A scoping review based on literature searches (Cumulative Index to Nursing and Allied Health Literature, Medical Literature Analysis and Retrieval System Online, Excerpta Medica Database, PsycINFO, Scopus, Health and Psychosocial Instruments, Dissertations and Theses Global, and Google Scholar) and predefined eligibility criteria was conducted as per current scoping review guidelines. FINDINGS Overall, 14 assessment tools were identified having been developed in diverse ICU settings. The identified tools assess mainly anxiety and depressive symptoms and ICU stressors, and investigators have reported various validity and reliability metrics. It was unclear whether available tools can be used in specific groups, such as noncommunicative patients and patients with delirium, brain trauma, stroke, sedation, and cognitive impairments. CONCLUSION Available tools have methodological limitations worth considering in future investigations. Given the high prevalence of psychiatric morbidity in ICU survivors, rigorously exploring the metric integrity of available tools used for anxiety, depressive, and psychological distress symptom assessment in the vulnerable ICU population is a practice and research priority. RELEVANCE TO CLINICAL PRACTICE These results have implications for the selection and implementation of psychological distress assessment methods as a means for promoting meaningful patient-centred clinical outcomes and humanising ICU care experiences.
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Affiliation(s)
- Elizabeth Kusi-Appiah
- Faculty of Nursing, University of Alberta, Edmonton Clinic Health Academy, Edmonton, AB, T6G 1C9, Canada.
| | - Maria Karanikola
- Cyprus University of Technology, Department of Nursing, 15 Vragadinou str-Limassol, 3041, Cyprus.
| | - Usha Pant
- Faculty of Nursing, University of Alberta, Edmonton Clinic Health Academy, Edmonton, AB, T6G 1C9, Canada.
| | - Shaista Meghani
- Faculty of Nursing, University of Alberta, Edmonton Clinic Health Academy, Edmonton, AB, T6G 1C9, Canada.
| | - Megan Kennedy
- John W. Scott Health Sciences Librarian, University of Alberta Library, 2K3.28 Walter C. Mackenzie Health Sciences Centre, Edmonton, AB, T6G 2R7, Canada.
| | - Elizabeth Papathanassoglou
- Faculty of Nursing, University of Alberta, Edmonton Clinic Health Academy, Edmonton, AB, T6G 1C9, Canada.
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Deng P, Hao L, Deng Y, Yao R, Cao Y. Pre-emptive remifentanil alleviates pain associated with tracheal suctioning in patients under mechanical ventilation and goal-directed sedation: A randomized controlled feasibility trial. Int J Nurs Pract 2021; 28:e12915. [PMID: 33403734 DOI: 10.1111/ijn.12915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 11/14/2020] [Accepted: 12/10/2020] [Indexed: 02/05/2023]
Abstract
AIMS To investigate the efficacy of pre-emptive remifentanil in alleviating pain during tracheal suctioning in patients under mechanical ventilation. BACKGROUND Goal-directed sedation is recommended for patients under mechanical ventilation by the current guidelines. Whether goal-directed sedation can prevent pain during tracheal suctioning in these patients is unknown. DESIGN This was a two-centre, randomized, crossover, single-blind trial conducted between August and October 2019. METHODS Patients under mechanical ventilation received low-dose remifentanil, high-dose remifentanil or placebo prior to each tracheal suctioning in a random order. The primary outcomes were evaluated using the critical-care pain observation tool and Richmond agitation-sedation scale after tracheal suctioning. Adverse events were also documented. RESULTS A total of 39 patients who underwent 117 tracheal suctions were enrolled. After the tracheal suction, changes in the critical-care pain observation tool and Richmond agitation-sedation scale scores were significantly lower in the low-dose and high-dose groups than in the placebo group (P < 0.001). A non-significant increase in the absence of spontaneous breathing was observed in the high-dose group compared to that in the placebo group. CONCLUSION A pre-emptive remifentanil bolus of 0.5 μg/kg can mitigate the pain associated with tracheal suctioning.
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Affiliation(s)
- Peng Deng
- Department of Emergency Medicine, Laboratory of Emergency Medicine, West China Hospital, and Disaster Medical Center, Sichuan University, Chengdu, China
| | - Liqun Hao
- Department of Emergency Medicine, Shangjinnanfu of West China Hospital, Chengdu, China
| | - Yan Deng
- Department of Emergency Medicine, Laboratory of Emergency Medicine, West China Hospital, and Disaster Medical Center, Sichuan University, Chengdu, China
| | - Rong Yao
- Department of Emergency Medicine, Laboratory of Emergency Medicine, West China Hospital, and Disaster Medical Center, Sichuan University, Chengdu, China
| | - Yu Cao
- Department of Emergency Medicine, Laboratory of Emergency Medicine, West China Hospital, and Disaster Medical Center, Sichuan University, Chengdu, China
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Gezginci E, Goktas S, Orhan BN. The effects of environmental stressors in intensive care unit on anxiety and depression. Nurs Crit Care 2020; 27:113-119. [PMID: 32954635 DOI: 10.1111/nicc.12553] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 09/03/2020] [Accepted: 09/04/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Physical and emotional conditions of patients treated in an intensive care unit (ICU) may be adversely affected by environmental stressors. AIMS AND OBJECTIVES The aim of this study was to investigate the relationship between patients' anxiety and depression levels and environmental stressors in the ICU. DESIGN This was a descriptive cross-sectional study. METHODS The study was conducted between June 2018 and April 2019 with 150 patients treated in the ICUs of a training and research hospital. Patient information form and ICU environmental stressors and hospital anxiety and depression scales were used for data collection. Descriptive statistics, t-test, one-way analysis of variance, and Pearson's correlation coefficient were used to evaluate the data. RESULTS The mean hospital anxiety score of the patients in ICUs was 11.1 ± 2.7, and 77.3% of patients were at risk for anxiety (10-point cut-off). The mean hospital depression score was 10.6 ± 3.3, and 94% of patients were at risk for depression (7-point cut-off). The mean score of environmental stressors was 123.9 ± 13.1. A moderate positive correlation between hospital anxiety and hospital depression (r = .63, P < .001) and a weak negative correlation between environmental stressors and hospital anxiety (r = -.24, P = .003) were found. However, no significant correlation between environmental stressors and hospital depression was found (r = -.13, P = .12). CONCLUSION According to this study, the environmental stressors in the ICU were high, and the patients were at risk of anxiety and depression. The depression levels of the patients increased along with their anxiety levels. As environmental stressors increased, hospital anxiety levels of the patients decreased. However, there was no significant relationship between environmental stressors and patients' hospital depression levels. RELEVANCE TO CLINICAL PRACTICE Environmental stressors in ICUs are high, and the patients in the ICUs are at risk of anxiety and depression.
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Affiliation(s)
- Elif Gezginci
- Hamidiye Faculty of Nursing, University of Health Sciences Turkey, Istanbul, Turkey
| | - Sonay Goktas
- Hamidiye Faculty of Nursing, University of Health Sciences Turkey, Istanbul, Turkey
| | - Busra Nur Orhan
- Marmara University Pendik Training and Research Hospital, Istanbul, Turkey
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Leemhuis A, Shichishima Y, Puntillo K. Palliation of Thirst in Intensive Care Unit Patients: Translating Research Into Practice. Crit Care Nurse 2020; 39:21-28. [PMID: 31575591 DOI: 10.4037/ccn2019544] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Thirst is prevalent among patients in intensive care units. A research-based "thirst bundle" was shown to significantly decrease thirst in these patients. OBJECTIVE To implement a research-based thirst intervention performed by intensive care unit nurses and patients' family members. METHODS Nurses and family members were taught the thirst intervention through video training and project team reinforcement. The intervention was performed by nurses for 123 patients and by family members for 13 patients. Thirst was measured with a numeric rating scale of 0 to 10, a word scale of 0 to 3, or "yes/no" answers, whichever was easiest for the patient. Inferential statistics were used to assess changes in thirst scores over time. Also assessed were nurse and family member burden levels, family level of satisfaction, and patient enjoyment. RESULTS Thirst scores on the numeric rating scale decreased significantly: from a mean (SD) of 7.9 (2.0) before to 3.9 (2.7) after the intervention for nurses (P < .001); and from 9.2 (1.5) to 5.3 (2.6) for family members (n = 13; P = .002). Word scale scores also decreased significantly, from a median (interquartile range) of 3 (3-3) before to 2 (1-2) after the intervention for nurses (P < .001). Most patients (96%) reported enjoying the procedure. Median burden levels were less than 2 on a numeric rating scale of 0 to 10. CONCLUSIONS The palliative "thirst bundle" significantly alleviated patients' thirst and resulted in little caregiver burden. Further efforts are warranted to incorporate this intervention into intensive care unit practice.
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Affiliation(s)
- Ann Leemhuis
- Ann Leemhuis is clinical nurse III, adult medical-surgical intensive care unit, University of California San Francisco Medical Center, San Francisco, California. Yuriko Shichishima is a clinical nurse II and a clinical nurse educator, Department of Community Health Systems, School of Nursing, University of California San Francisco Medical Center. Kathleen Puntillo is professor emeritus, Department of Physiological Nursing, University of California San Francisco School of Nursing
| | - Yuriko Shichishima
- Ann Leemhuis is clinical nurse III, adult medical-surgical intensive care unit, University of California San Francisco Medical Center, San Francisco, California. Yuriko Shichishima is a clinical nurse II and a clinical nurse educator, Department of Community Health Systems, School of Nursing, University of California San Francisco Medical Center. Kathleen Puntillo is professor emeritus, Department of Physiological Nursing, University of California San Francisco School of Nursing
| | - Kathleen Puntillo
- Ann Leemhuis is clinical nurse III, adult medical-surgical intensive care unit, University of California San Francisco Medical Center, San Francisco, California. Yuriko Shichishima is a clinical nurse II and a clinical nurse educator, Department of Community Health Systems, School of Nursing, University of California San Francisco Medical Center. Kathleen Puntillo is professor emeritus, Department of Physiological Nursing, University of California San Francisco School of Nursing
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Mistraletti G, Umbrello M, Mariani V, Carloni E, Miori S, Taverna M, Sabbatini G, Formenti P, Terzoni S, Destrebecq AL, Chiumello D, Moja EA, Iapichino G. Conscious sedation in critically ill patients is associated with stressors perception lower than assessed by caregivers. Minerva Anestesiol 2018; 84:1150-1159. [PMID: 29589416 DOI: 10.23736/s0375-9393.18.12425-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND In ICU, the stay is frequently a stressful experience. Caregivers may help to understand patients' perceptions; however, their reliability is uncertain. Despite the recent recommendations of lighter sedation targets, little is known about the impact of "conscious sedation" on ICU patients memories. Purpose of this prospective, observational study is to analyze the stress perception in consciously-sedated ICU-patients, comparing it to caregivers and staff members. METHODS Twenty-nine high-risk ICU-patients treated with awake/cooperative sedation were enrolled. Before discharge, patients received a validated questionnaire for ICU stressors evaluation, also administered to their main caregiver (N.=29), to caregivers of other ICU patients not enrolled in the study (N.=33) and to staff members (ICU nurses, attending physicians, residents, medical students, N.=56). RESULTS Total stress score was: patients 141±41, patient relatives 210±63, other relatives: 202±73, ICU staff: 232±44, P<0.001. Among patients, older age (P=0.031), longer ICU-stay (P=0.018) and awake-sedation (P=0.022) were associated with lower stress; sex and illness severity had no effect; mechanical ventilation length (P=0.021) and agitation (P=0.029) were associated with higher stress. Nurses tended to overestimate stressors more than attending physicians and trainees. Within staff members, age (P=0.021) and years of experience (P=0.069) were positively associated with overestimation. CONCLUSIONS Conscious sedation is associated with stress perception lower than stress assessed by caregivers: relatives and staff members tend to overestimate ICU patient stress, more so with increasing age or expertise. A number of stressors underestimated by staff and families could be target of specific interventions to ameliorate quality of life during ICU stay.
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Affiliation(s)
- Giovanni Mistraletti
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy - .,Department of Anesthesia and Intensive Care, ASST Santi Paolo e Carlo, San Paolo University Hospital, Milan, Italy -
| | - Michele Umbrello
- Department of Anesthesia and Intensive Care, ASST Santi Paolo e Carlo, San Paolo University Hospital, Milan, Italy
| | - Vera Mariani
- Department of Health Sciences, University of Milan, Milan, Italy
| | | | - Sara Miori
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Martina Taverna
- Department of Anesthesia and Intensive Care, ASST Santi Paolo e Carlo, San Paolo University Hospital, Milan, Italy
| | - Giovanni Sabbatini
- Department of Anesthesia and Intensive Care, ASST Santi Paolo e Carlo, San Paolo University Hospital, Milan, Italy
| | - Paolo Formenti
- Department of Anesthesia and Intensive Care, ASST Santi Paolo e Carlo, San Paolo University Hospital, Milan, Italy
| | - Stefano Terzoni
- Department of Health Sciences, University of Milan, Milan, Italy
| | | | - Davide Chiumello
- Department of Anesthesia and Intensive Care, ASST Santi Paolo e Carlo, San Paolo University Hospital, Milan, Italy.,Department of Health Sciences, University of Milan, Milan, Italy
| | - Egidio A Moja
- Department of Health Sciences, University of Milan, Milan, Italy
| | - Gaetano Iapichino
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.,Department of Anesthesia and Intensive Care, ASST Santi Paolo e Carlo, San Paolo University Hospital, Milan, Italy
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Gültekin Y, Özçelik Z, Akıncı SB, Yorgancı HK. Evaluation of stressors in intensive care units. Turk J Surg 2018; 34:5-8. [PMID: 29756097 DOI: 10.5152/turkjsurg.2017.3736] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Accepted: 01/31/2017] [Indexed: 11/22/2022]
Abstract
Objective Physical and psychological stressors adversely affect the treatment and length of stay of patients in intensive care units. In this study, we aimed to describe environmental and psychological stressors affecting intensive care unit patients and to determine their priorities. Material and Methods In this study, the 40-item Intensive Care Unit Environmental Stressor Scale was administered to patients in the General Surgery Intensive Care Unit and the Anesthesiology and Reanimation Intensive Care Unit. The patients' age, gender, marital status, educational status, cause of hospitalization, and intensive care unit length of stay were questioned and recorded. Acute Physiology And Chronic Health Evaluation II scores were determined for intensive care unit patients. Results A total of 98 patients, 80 in the General Surgery Intensive Care Unit and 18 in the Anesthesiology and Reanimation Intensive Care Unit, were included in the study between May 1, 2015 and October 31, 2015. Fifty-six of the patients were male (57.1%) and 42 were female (42.9%). The mean age of the patients was 55.1±15.1 years. The mean intensive care unit length of stay was 3.4±1.6 days. The median Acute Physiology And Chronic Health Evaluation II score of the patients was 6 (0 to 17). The patients were most affected by thirst (mean 2.44). The second most stressful stress factor was the presence of tubes in the mouth and nose (mean 2.25). The least stressful factor for the patients was the presence of nurses constantly performing activities around the bed. Although 51% of the patients were postoperative, pain was ranked 5th among stress factors. Conclusion The environmental and psychological factors affecting intensive care unit patients varied according to age, sex, and educational and surgical status. These factors had adverse effects on the patients. The elimination or modification of these factors would contribute positively to the treatment of intensive care unit patients and shorten their length of stay in the intensive care unit.
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Affiliation(s)
- Yücel Gültekin
- Division Intensive Care, Department of General Surgery, Hacettepe University School of Medicine, Ankara, Turkey
| | - Zerrin Özçelik
- Division Intensive Care, Department of Anesthesiology and Reanimation, Hacettepe University School of Medicine, Ankara, Turkey
| | - Seda Banu Akıncı
- Division Intensive Care, Department of Anesthesiology and Reanimation, Hacettepe University School of Medicine, Ankara, Turkey
| | - Halil Kaya Yorgancı
- Department of General Surgery, Hacettepe University School of Medicine, Ankara, Turkey
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Carrillo-Torres O, Ramirez-Torres M, Mendiola-Roa M. Update on the assessment and treatment of pain in critically ill patients. REVISTA MÉDICA DEL HOSPITAL GENERAL DE MÉXICO 2016. [DOI: 10.1016/j.hgmx.2016.05.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Kalfon P, Mimoz O, Loundou A, Geantot MA, Revel N, Villard I, Amour J, Azoulay E, Garrouste-Orgeas M, Martin C, Sharshar T, Baumstarck K, Auquier P. Reduction of self-perceived discomforts in critically ill patients in French intensive care units: study protocol for a cluster-randomized controlled trial. Trials 2016; 17:87. [PMID: 26880373 PMCID: PMC4754872 DOI: 10.1186/s13063-016-1211-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 02/04/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND It is now well documented that critically ill patients are exposed to stressful conditions and experience discomforts from multiple sources. Improved identification of the discomforts of patients in intensive care units (ICUs) may have implications for managing their care, including consideration of ethical issues, and may assist clinicians in choosing the most appropriate interventions. The primary objective of this study was to assess the effectiveness of a multicomponent program of discomfort reduction in critically ill patients. The secondary objectives were to assess the sustainability of the impact of the program and the potential seasonality effect. METHODS/DESIGN We conducted a multicenter, cluster-randomized, controlled, single (patient)-blind study involving 34 French adult ICUs. The experimental intervention was a 6-month period during which the multicomponent program was implemented in the ICU and included the following steps: identification of discomforts, immediate feedback to the healthcare team, and implementation of targeted interventions. The control intervention was a 6-month period during which any program was implemented. The primary endpoint was the monthly overall score of self-reported discomfort from the French questionnaire on discomforts in ICU patients (IPREA). The secondary endpoints were the scores of the discomfort items of IPREA. The sample size was 660 individuals to obtain 80% power to detect a 25% difference in the overall discomfort score of IPREA between the two groups (design effect: 2.9). DISCUSSION The results of this cluster-randomized controlled study are expected to confirm that a multicomponent program of discomfort reduction may be a new strategy in the management of care for critically ill patients. TRIAL REGISTRATION ClinicalTrials.gov NCT02442934, registered 11 May 2015.
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Affiliation(s)
- Pierre Kalfon
- Service de réanimation, Centre Hospitalier Louis Pasteur, Chartres, France.
| | - Olivier Mimoz
- Centre Hospitalier Universitaire (CHU) La Miletrie, Poitiers, France.
| | - Anderson Loundou
- EA3279 Self-perceived Health Assessment Research Unit Aix-Marseille University, Marseille, France.
| | | | | | - Isabelle Villard
- CHU Beaujon, Assistance Publique - Hôpitaux de Paris (APHP), Clichy, France.
| | | | | | | | - Claude Martin
- CHU Hôpital Nord, Assistance Publique - Hôpitaux de Marseille, Marseille, France.
| | | | - Karine Baumstarck
- EA3279 Self-perceived Health Assessment Research Unit Aix-Marseille University, Marseille, France.
| | - Pascal Auquier
- EA3279 Self-perceived Health Assessment Research Unit Aix-Marseille University, Marseille, France.
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Abstract
The purpose of this cross-sectional study was to identify the stressors and the level of stress as perceived by hospitalised Syrian patients of intensive care units (ICUs). A convenience sample of 150 Syrians who were hospitalised in ICUs located in the Syrian capital, Damascus, were chosen as study participants and were interviewed using a structured interview guide of the Intensive Care Units Environmental Stressors Scale (ICUESS). The findings revealed that physical stressors were perceived as the most stressful ones, whereas psychological stressors were the least stressful. These findings are congruent with the majority of similarly available regional and international literature. It was also statistically noticed that participants with a higher level of education and income were more sensitive in perceiving the stressors than those who had a lower level of education and income. The findings suggested that nurses must utilise effective measures in ICUs to relieve patients' pain and provide a humane ICU environment and atmosphere in which rest is enabled. In conclusion, decreasing the stress level has a positive impact on patients' health outcomes, where adequate attention to patients' physical and psychological domains should equally be considered.
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Affiliation(s)
- Issa M Hweidi
- Associate Professor, School of Nursing, Adult Health Nursing Department, Jordan University of Science and Technology, Jordan
| | - Frial M Nizamli
- Master-prepared Nurse, Faculty of Nursing, Adult Health Nursing Department, Jordan University of Science and Technology, Jordan
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Puntillo KA, Max A, Timsit JF, Vignoud L, Chanques G, Robleda G, Roche-Campo F, Mancebo J, Divatia JV, Soares M, Ionescu DC, Grintescu IM, Vasiliu IL, Maggiore SM, Rusinova K, Owczuk R, Egerod I, Papathanassoglou EDE, Kyranou M, Joynt GM, Burghi G, Freebairn RC, Ho KM, Kaarlola A, Gerritsen RT, Kesecioglu J, Sulaj MMS, Norrenberg M, Benoit DD, Seha MSG, Hennein A, Periera FJ, Benbenishty JS, Abroug F, Aquilina A, Monte JRC, An Y, Azoulay E. Determinants of procedural pain intensity in the intensive care unit. The Europain® study. Am J Respir Crit Care Med 2014; 189:39-47. [PMID: 24262016 DOI: 10.1164/rccm.201306-1174oc] [Citation(s) in RCA: 140] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Intensive care unit (ICU) patients undergo several diagnostic and therapeutic procedures every day. The prevalence, intensity, and risk factors of pain related to these procedures are not well known. OBJECTIVES To assess self-reported procedural pain intensity versus baseline pain, examine pain intensity differences across procedures, and identify risk factors for procedural pain intensity. METHODS Prospective, cross-sectional, multicenter, multinational study of pain intensity associated with 12 procedures. Data were obtained from 3,851 patients who underwent 4,812 procedures in 192 ICUs in 28 countries. MEASUREMENTS AND MAIN RESULTS Pain intensity on a 0-10 numeric rating scale increased significantly from baseline pain during all procedures (P < 0.001). Chest tube removal, wound drain removal, and arterial line insertion were the three most painful procedures, with median pain scores of 5 (3-7), 4.5 (2-7), and 4 (2-6), respectively. By multivariate analysis, risk factors independently associated with greater procedural pain intensity were the specific procedure; opioid administration specifically for the procedure; preprocedural pain intensity; preprocedural pain distress; intensity of the worst pain on the same day, before the procedure; and procedure not performed by a nurse. A significant ICU effect was observed, with no visible effect of country because of its absorption by the ICU effect. Some of the risk factors became nonsignificant when each procedure was examined separately. CONCLUSIONS Knowledge of risk factors for greater procedural pain intensity identified in this study may help clinicians select interventions that are needed to minimize procedural pain. Clinical trial registered with www.clinicaltrials.gov (NCT 01070082).
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Affiliation(s)
- Kathleen A Puntillo
- 1 Department of Physiological Nursing, University of California, San Francisco, San Francisco, California
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Recognition of the primary stressors affecting intensive care patients: a systematic review. Crit Care 2013. [PMCID: PMC3642904 DOI: 10.1186/cc12480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit. Crit Care Med 2013; 41:263-306. [PMID: 23269131 DOI: 10.1097/ccm.0b013e3182783b72] [Citation(s) in RCA: 2284] [Impact Index Per Article: 207.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To revise the "Clinical Practice Guidelines for the Sustained Use of Sedatives and Analgesics in the Critically Ill Adult" published in Critical Care Medicine in 2002. METHODS The American College of Critical Care Medicine assembled a 20-person, multidisciplinary, multi-institutional task force with expertise in guideline development, pain, agitation and sedation, delirium management, and associated outcomes in adult critically ill patients. The task force, divided into four subcommittees, collaborated over 6 yr in person, via teleconferences, and via electronic communication. Subcommittees were responsible for developing relevant clinical questions, using the Grading of Recommendations Assessment, Development and Evaluation method (http://www.gradeworkinggroup.org) to review, evaluate, and summarize the literature, and to develop clinical statements (descriptive) and recommendations (actionable). With the help of a professional librarian and Refworks database software, they developed a Web-based electronic database of over 19,000 references extracted from eight clinical search engines, related to pain and analgesia, agitation and sedation, delirium, and related clinical outcomes in adult ICU patients. The group also used psychometric analyses to evaluate and compare pain, agitation/sedation, and delirium assessment tools. All task force members were allowed to review the literature supporting each statement and recommendation and provided feedback to the subcommittees. Group consensus was achieved for all statements and recommendations using the nominal group technique and the modified Delphi method, with anonymous voting by all task force members using E-Survey (http://www.esurvey.com). All voting was completed in December 2010. Relevant studies published after this date and prior to publication of these guidelines were referenced in the text. The quality of evidence for each statement and recommendation was ranked as high (A), moderate (B), or low/very low (C). The strength of recommendations was ranked as strong (1) or weak (2), and either in favor of (+) or against (-) an intervention. A strong recommendation (either for or against) indicated that the intervention's desirable effects either clearly outweighed its undesirable effects (risks, burdens, and costs) or it did not. For all strong recommendations, the phrase "We recommend …" is used throughout. A weak recommendation, either for or against an intervention, indicated that the trade-off between desirable and undesirable effects was less clear. For all weak recommendations, the phrase "We suggest …" is used throughout. In the absence of sufficient evidence, or when group consensus could not be achieved, no recommendation (0) was made. Consensus based on expert opinion was not used as a substitute for a lack of evidence. A consistent method for addressing potential conflict of interest was followed if task force members were coauthors of related research. The development of this guideline was independent of any industry funding. CONCLUSION These guidelines provide a roadmap for developing integrated, evidence-based, and patient-centered protocols for preventing and treating pain, agitation, and delirium in critically ill patients.
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Mpouzika MDA, Papathanassoglou EDE, Giannakopoulou M, Bozas E, Middleton N, Boti S, Patiraki EI, Karabinis A. Altered serum stress neuropeptide levels in critically ill individuals and associations with lymphocyte populations. Neuropeptides 2013; 47:25-36. [PMID: 22981820 DOI: 10.1016/j.npep.2012.07.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Revised: 07/06/2012] [Accepted: 07/19/2012] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Potential physiological correlates of stress and the role of stress neuropeptides, other than those of the hypothalamic-pituitary-adrenal axis, in critical illness have not been addressed. We investigated: (a) serum levels of stress neuropeptides (ACTH, substance P (SP), neuropeptide Y (NPY), cortisol, prolactin) in critically ill individuals compared to matched controls, (b) associations with lymphocyte counts, (c) associations among stress neuropeptide levels, and (d) associations with perceived intensity of stress, critical illness severity and survival. METHODS Correlational design with repeated measures. Thirty-six critically ill patients were followed up for 14 days compared to 36 healthy matched controls. Stress was assessed by the ICUESS scale. Correlations, cross-sectional comparisons and multiple regression models were pursued. RESULTS For the first time, we report lower SP (Difference of means (DM) = 2928-3286 ng/ml, p < 0.001) and NPY (DM = 0.77-0.83 ng/ml, p < 0.0001) levels in critically ill individuals compared to controls. Cortisol levels were higher (DM = 140-173 ng/ml, p<0.0001) and lymphocyte population counts (p < 0.002) were lower in patients throughout the study. NPY levels associated with lymphocyte (r = 0.411-0.664, p < 0.04), T-lymphocyte (r = 0.403-0.781, p< 0.05), T-helper (r = 0.492-0.690, p < 0.03) and T-cytotoxic cell populations (r = 0.39-0.740, p < 0.03). On day 1, cortisol levels exhibited associations with lymphocyte (r = -0.452, p = 0.01), T-cell (r = -0.446, p = 0.02), T-helper (r = -0.428, p = 0.026) and T-cytotoxic cells ( r = -0.426, p = 0.027). ACTH levels associated with NK cell counts (r = 0.326-0.441, p < 0.05). Associations among stress neuropeptides levels were observed throughout (p < 0.05). ACTH levels associated with disease severity (r = 0.340-0.387, p < 0.005). A trend for an association between ACTH levels and intensity of stress was noted (r = 0.340, p = 0.057). CONCLUSION The significantly lowered NPY and SP levels and the associations with cortisol, ACTH and lymphocytes suggest that the role of these peptides in critical illness merit further investigation. Future studies need to address associations between these neuropeptides and functional immune cell responses and inflammatory markers in critical illness.
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Affiliation(s)
- Meropi D A Mpouzika
- Department of Nursing B, Faculty of Health and Caring Professions, Technological Educational Institute of Athens, Greece.
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Armour AD, Khoury JC, Kagan RJ, Gottschlich MM. Clinical assessment of sleep among pediatric burn patients does not correlate with polysomnography. J Burn Care Res 2012; 32:529-34. [PMID: 21912335 DOI: 10.1097/bcr.0b013e31822ac844] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A vast amount of sleep research relies on subjective, observational assessments of wakefulness and sleep. The authors had the unique opportunity to compare observational and polysomnographic (PSG) determinations of sleep in a randomized crossover study of sleep-inducing medication in a group of pediatric burn patients. Pediatric burn patients were randomized to one of two regimens with sleep-inducing agents over a 2-week period. PSG was conducted for three consecutive nights each week, between 7-13 and 14-20 days postburn. The first night of monitoring each week was conducted without medication to serve as a baseline. Observational sleep assessments (awake, drowsy, or asleep) were simultaneously recorded every 15 minutes. PSG concordance with observation was based on the PSG sleep stages identified during the 2 minutes before the observations. If all 30-second epochs in the two minutes were designated as sleep stage 1 or above, then the PSG record was categorized as asleep. If all epochs demonstrated wakefulness, an awake status was recorded. Otherwise, the corresponding PSG finding was classified as mixed. Forty patients were enrolled into the study, with a mean age of 9.4 ± 0.6 years, TBSA burn of 50.1 ± 2.9%, and third-degree burn surface area of 43.2 ± 3.6%. Patients were judged according to observational criteria to be awake 9% of the nocturnal study period compared with PSG recordings indicating that the patients were awake 52.3% of the time. The correlation between observation and PSG was poor regardless of sleep agent administration. In conclusion, observational determination of wakefulness in pediatric burn patients correlates poorly with PSG; therefore, PSG is vital in the accurate evaluation of sleep-inducing medications among burn patients.
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Intérêt de l’évaluation quantitative des sources d’inconforts en réanimation. MEDECINE INTENSIVE REANIMATION 2011. [DOI: 10.1007/s13546-011-0292-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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McKay J, Vasilev SA. Perioperative Psychosocial Considerations. Gynecol Oncol 2011. [DOI: 10.1002/9781118003435.ch14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Yava A, Tosun N, Ünver V, Çiçek H. Patient and nurse perceptions of stressors in the intensive care unit. Stress Health 2011; 27:e36-47. [PMID: 27486622 DOI: 10.1002/smi.1333] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The objective of the study was to determine the perceptions of a group of patients on intensive care units' (ICUs) stressors and the perceptions of nurses on ICU patients' stressors in Turkey, and compare the differences in patients' and nurses' perception of the stressors in ICUs. In this descriptive study, 155 patients who were admitted to medical or surgical ICUs and 152 nurses who are employed in the same units of two training and research hospitals in Turkey were enrolled in this study. The ICU Environmental Stressor Scale (ICUESS) was used to determine intensive care stressors. According to total ICUESS mean scores, patients (91.41 ± 34.91) perceived significantly less stress than the ICU nurses (133.23 ± 32.20) perceived them to have. Both patients and nurses ranked 'fear of death' as the greatest stressor. Physiological stressors were identified as the most important stressors by both patients and nurses. Patients and nurses in medical ICUs were more affected by stressors than their counterparts in surgical ICUs. Patients with unplanned or emergency admissions perceived higher stress than that of patients with planned admissions. Several factors could help reduce these stressors, such as having familiar arrangements, humane ICU environment, individual patient assessments and appropriate nursing interventions.
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Affiliation(s)
- Ayla Yava
- Surgical Nursing, School of Nursing, Gülhane Military Medical Academy, Ankara, Turkey
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Abstract
OBJECTIVE To provide a focused, detailed assessment of the symptom experiences of intensive care unit patients at high risk of dying and to evaluate the relationship between delirium and patients' symptom reports. DESIGN Prospective, observational study of patients' symptoms. SETTING Two intensive care units in a tertiary medical center in the western United States. PATIENTS One hundred seventy-one intensive care unit patients at high risk of dying. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Patients were interviewed every other day for up to 14 days. Patients rated the presence, intensity (1 = mild; 2 = moderate; 3 = severe), and distress (1 = not very distressing; 2 = moderately distressing; 3 = very distressing) of ten symptoms (that is, pain, tired, short of breath, restless, anxious, sad, hungry, scared, thirsty, confused). The Confusion Assessment Method-Intensive Care Unit was used to ascertain the presence of delirium. A total of 405 symptom assessments were completed by 171 patients. Patients' average age was 58 ± 15 yrs; 64% were males. Patients were mechanically ventilated during 34% of the 405 assessments, and 22% died in the hospital. Symptom prevalence ranged from 75% (tired) to 27% (confused). Thirst was moderately intense, and shortness of breath, scared, confusion, and pain were moderately distressful. Delirium was found in 34.2% of the 152 patients who could be evaluated. Delirious patients were more acutely ill and received significantly higher doses of opioids. Delirious patients were significantly more likely to report feeling confused (43% vs. 22%, p = .004) and sad (46% vs. 31%, p = .04) and less likely to report being tired (57% vs. 77%, p = .006) than nondelirious patients. CONCLUSIONS Study findings suggest that unrelieved and distressing symptoms are present for the majority of intensive care unit patients, including those with delirium. Symptom assessment in high-risk intensive care unit patients may lead to more focused interventions to avoid or minimize unnecessary suffering.
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Rosa BÂ, Rodrigues RCM, Gallani MCBJ, Spana TM, Pereira CGDS. Estressores em Unidade de Terapia Intensiva: versão brasileira do The Environmental Stressor Questionnaire. Rev Esc Enferm USP 2010; 44:627-35. [DOI: 10.1590/s0080-62342010000300011] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Este estudo teve como objetivo realizar a adaptação cultural do The Environmental Stressor Questionnaire - (ESQ) para a língua portuguesa do Brasil e verificar sua confiabilidade e validade. Foram empregadas as etapas metodológicas recomendadas pela literatura para adaptação cultural. A versão brasileira do ESQ foi aplicada a 106 pacientes de Unidade de Terapia Intensiva (UTI) de dois hospitais, público e privado, do interior do Estado de São Paulo. A confiabilidade foi avaliada quanto à consistência interna e estabilidade (teste e reteste); a validade convergente foi verificada por meio da correlação entre o ESQ e questão genérica sobre estresse em UTI. A confiabilidade foi satisfatória com Alfa de Crombach=0,94 e Coeficiente de Correlação Intraclasse=0,861 (IC95% 0,723; 0,933). Constatou-se correlação entre o escore total do ESQ e a questão genérica sobre estresse (r=0,70), confirmando a validade convergente. A versão brasileira do ESQ mostrou-se uma ferramenta confiável e válida para avaliação de estressores em UTI.
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Development and validation of a questionnaire for quantitative assessment of perceived discomforts in critically ill patients. Intensive Care Med 2010; 36:1751-1758. [PMID: 20502874 DOI: 10.1007/s00134-010-1902-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2009] [Accepted: 04/17/2010] [Indexed: 02/06/2023]
Abstract
PURPOSE To develop and validate the IPREA (Inconforts des Patients de REAnimation) questionnaire for the assessment of discomfort perceived by patients related to their intensive care unit (ICU) stay. METHODS This was a two step-study comprising a phase of item generation conducted in one ICU and a phase of psychometric evaluation during a multicenter prospective cohort study in 14 ICUs. Patients were unselected consecutive adult surviving ICU patients. On the day of ICU discharge, a nurse asked patients to rate the severity of 16 discomfort sources, from 0 to 100. Ten percent of patients were randomly chosen to be questioned again to assess the reproducibility. RESULTS Of 1,380 eligible patients, 1,113 survived and 868 patients could be questioned. The highest scores were for sleep deprivation (35 ± 33), being restrained by tubing, wires, and cables (33 ± 30), pain (32 ± 30), and thirst (32 ± 34). No multidimensional structure was identified. The mean overall score of discomfort was 22 ± 14. Internal consistency was satisfactory using Cronbach's alpha coefficient (0.78). The test-retest reliability study found average measure intraclass correlations ranging from 0.70 to 0.92. The mean duration of the questionnaire administration was 10 ± 7 min. CONCLUSION The psychometric properties and acceptability of the IPREA questionnaire make it a potential instrument for measuring discomfort perceived by unselected ICU patients.
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Costa JBD, Felicetti CR, Costa CRLDM, Miglioranza DC, Osaku EF, Versa GLGDS, Solstoski J, Duarte PAD, Duarte ST, Ogasawara SM, Taba S. Fatores estressantes para familiares de pacientes criticamente enfermos de uma unidade de terapia intensiva. JORNAL BRASILEIRO DE PSIQUIATRIA 2010. [DOI: 10.1590/s0047-20852010000300003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJETIVO: Identificar os principais estressores ambientais, conforme a percepção de familiares de pacientes internados em uma UTI-G de adultos de um hospital público universitário. MÉTODO: Estudo transversal descritivo com familiares de pacientes gravemente enfermos internados na UTI de um hospital escola. Para a coleta de dados, utilizou-se uma escala contendo 25 itens relacionados a eventos da referida UTI. Para análise dos resultados, as respostas foram classificadas como estressores ambientais, referentes à equipe, ao paciente e à visita. RESULTADOS: Participaram 53 familiares, 67,9% mulheres, com média de idade de 39,7 anos. Os fatores relacionados ao paciente foram mais estressantes do que aqueles referentes à equipe e ao ambiente (p < 0,005). Os eventos mais estressantes para os familiares estiveram relacionados à insegurança e ao medo quanto ao estado clínico do paciente, dentre esses, o motivo e o tempo de internação e ver o paciente em coma. CONCLUSÃO: A internação de um parente próximo na UTI foi considerada pelos familiares que efetivamente participaram desse processo um evento estressante. Todos os participantes indicaram pelo menos um evento causador de estresse capaz de provocar diferentes reações emocionais. Conhecer tais eventos pode facilitar as estratégias de humanização hospitalar, propiciando alternativas para reduzir os níveis de estresse e alterações psiquiátricas subsequentes.
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Gottschlich MM, Khoury J, Warden GD, Kagan RJ. An evaluation of the neuroendocrine response to sleep in pediatric burn patients. JPEN J Parenter Enteral Nutr 2009; 33:317-26. [PMID: 19223527 DOI: 10.1177/0148607108325180] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Previous work demonstrated reduced stage 3+4 and rapid eye movement (REM) sleep following burn injury. This study evaluated the hormonal effects of drug intervention on measures of endocrine status. A secondary objective examined the relationship between hormones and sleep stage distribution. METHODS Forty patients 3-18 years of age with a mean percent total body surface area burn of 50.1 +/- 2.9 were randomly assigned to zolpidem or haloperidol utilizing a blinded crossover design. Polysomnography was performed 6 nights, 3/week over 2 weeks. Each week's first night of monitoring was conducted without medication, serving as a baseline. Hormonal levels (epinephrine, norepinephrine, growth hormone, melatonin, dehydroepiandrosterone [DHEA], serotonin, cortisol) were obtained at 0600 h each study day. RESULTS Both drugs were associated with increased DHEA levels (P < .03); no other hormones were affected by medication. Significant inverse correlation was observed between REM sleep and epinephrine (r = -.34, P = .004) and norepinephrine levels (r = -.45, P = .02). A positive relationship existed between serotonin and sleep stage 3+4 (r = 0.24, P = .01) and REM (r = 0.48, P = .01). No other significant associations were identified between hormones and sleep. CONCLUSIONS This work characterizes the relationship between sleep deprivation and select endocrine parameters postburn. Drug interventions utilized in this study were either ineffective or insufficient in modulating improved hormonal response. Significance of zolpidem's and haloperidol's effect on serum levels of DHEA is unclear. The inverse correlation of epinephrine with REM may suggest that hypermetabolism associated with burns is partly due to lack of REM sleep. Questions remain regarding the effects of sleep deprivation on metabolism and clinical outcome.
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Affiliation(s)
- Michele M Gottschlich
- Department of Nutrition, Shriners Hospitals for Children, Cincinnati, OH 45229, USA.
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Hofhuis JGM, Spronk PE, van Stel HF, Schrijvers AJP, Rommes JH, Bakker J. Experiences of critically ill patients in the ICU. Intensive Crit Care Nurs 2008; 24:300-13. [PMID: 18472265 DOI: 10.1016/j.iccn.2008.03.004] [Citation(s) in RCA: 113] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2007] [Revised: 03/14/2008] [Accepted: 03/20/2008] [Indexed: 11/25/2022]
Abstract
BACKGROUND Experiences of critically ill patients are an important aspect of the quality of care in the intensive care (ICU). OBJECTIVE The aims of the study were firstly, to evaluate the perceptions of patients regarding nursing care in the ICU, and secondly, to explore patients' perceptions and experiences of ICU stay. METHOD A qualitative approach using a semi-structured focused interview in 11 patients was used (phase 1), followed by a quantitative approach using a self-reported questionnaire in 100 patients, 62 were returned and 50 could be evaluated (phase 2). RESULTS A number of themes emerged from the interviews (phase 1), although support dominated as an important key theme. This was experienced as a continuum from the feeling being supported by the nurse to not being supported. This key theme was central to each of the three categories emerging from the data pertaining to: (1) providing the seriously ill patient with information and explanation, (2) placing the patient in a central position and (3) personal approach by the nurse. The responders to the subsequent questionnaire (phase 2) predominantly experienced sleeping disorders (48%), mostly related to the presence of noise (54%). Psychological problems after ICU stay were reported by 11% of the patients, i.e. fear, inability to concentrate, complaints of depression and hallucinations. CONCLUSIONS Although the nurses' expertise and technical skills are considered important, caring behaviour, relieving the patient of fear and worries were experienced as most valuable in bedside critical care.
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Affiliation(s)
- José G M Hofhuis
- Department of Intensive Care Medicine, Gelre Hospital, Lukas, Apeldoorn, The Netherlands.
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A Randomized, Controlled Prospective Trial of Zolpidem and Haloperidol for Use as Sleeping Agents in Pediatric Burn Patients. J Burn Care Res 2008; 29:238-47. [DOI: 10.1097/bcr.0b013e31815f384e] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Gómez-Carretero P, Monsalve V, Soriano JF, de Andrés J. Alteraciones emocionales y necesidades psicológicas de pacientes en una Unidad de Cuidados Intensivos. Med Intensiva 2007; 31:318-25. [PMID: 17663957 DOI: 10.1016/s0210-5691(07)74830-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
From the time when a disease whose treatment is going to require hospitalization for a surgical intervention is diagnosed, both the patient and his/her family members or primary caretakers are involved in a process that may involve the experience of several emotional alterations. This work focuses on the description of the different psychological problems and needs manifested by the patients who require, as part of the treatment process and recovery control, admission to an Intensive Care Unit (ICU). During the patient's stay in the ICU, the emotional alterations mentioned most frequently by them are anxiety, stress, depression or the so-called intensive care syndrome, during which factors such as excessive noise that may make sleeping and rest difficult, pain, the methods used for ventilation that prevent the patients from communicating adequately, etc. Furthermore, the patients generally develop a feeling of loss of self-control, the main needs described being the sensation of safety and "knowing what is happening". The experiences lived may continue to produce emotional alterations even months after hospital discharge, with the development of a Posttraumatic Stress Disorder. This justifies a follow-up in order to detect them and treat them adequately. It seems to be appropriate for the treatment of these patients to be multidisciplinary, attending to both the physical needs related with the disease as well as the psychological ones.
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Affiliation(s)
- P Gómez-Carretero
- Investigación, Sociedad Valenciana para el Estudio y Tratamiento del Dolor, Avenida De la Plana 20, 46460 Valencia, Spain.
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Hweidi IM. Jordanian patients’ perception of stressors in critical care units: A questionnaire survey. Int J Nurs Stud 2007; 44:227-35. [PMID: 16426614 DOI: 10.1016/j.ijnurstu.2005.11.025] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2005] [Revised: 09/27/2005] [Accepted: 11/24/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND Critical care units' CCUs environment has been regarded as a leading stressor because of the complex nature of patient's health problems that require an extensive use of very sophisticated technology. Multiple and complex care predominates in CCUs have been described by patients to be stressful and emotionally demanding. RATIONALE Number of CCUs in Jordan has been increasing and so does the advanced technology, which calls for adaptability in dealing with unit stressors as they affect patient recovery and rehabilitation. OBJECTIVES To identify the principal physical and psychological stressors as perceived by Jordanian patients in CCUs and to examine the effects of selected patients' characteristics on their perception of stressors. METHODS In this cross-sectional study, data was collected from 165 patients, 2-3 days after being discharged from CCUs in two Jordanian governmental hospitals. A structured interview guide including the Intensive Care Unit Environmental Stressor Scale was used. RESULTS Having tubes in nose or mouth, being in pain, not able to sleep and hearing the buzzers and alarms from the machinery, being thirsty, and not being in control of your-self were considered by patients as the main stressors. Psychological stressors were the least stressful items identified by patients. Marital status, educational level, age, and income were the most significant characteristics which affected patients' perception of stressors. CONCLUSIONS The findings suggest that single and older patients with low income and low education experience more difficulties than their counterparts. Nurses must utilize more effective communication techniques and interventions to relieve patients' pain, and provide an atmosphere in which rest is possible, with less light, noise, and the fewest possible interruptions. Although the results of this study indicate the need to provide the best possible physical care, it is equally important to give adequate attention to patients' and families' psychological aspects.
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Affiliation(s)
- Issa M Hweidi
- School of Nursing, Adult Health Nursing Department, Jordan University of Science and Technology, P.O. Box 3030, Irbid 22110, Jordan.
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Marosti CA, Dantas RAS. Relation between stressors and sociodemographic and clinical characteristics of patients hospitalized at a coronary unit. Rev Lat Am Enfermagem 2006; 14:713-9. [PMID: 17117255 DOI: 10.1590/s0104-11692006000500012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2005] [Accepted: 07/03/2006] [Indexed: 11/21/2022] Open
Abstract
This descriptive study aimed to correlate the stressors of patients hospitalized at a coronary care unit and their sociodemographic and clinical characteristics. We interviewed 43 patients who were hospitalized at a large hospital. The stressors were evaluated by means of a 4-point Likert scale, which measured stress intensity for 42 possible stressors, ranging from 1 (not stressful) to 4 (very stressful). We collected data on sociodemographic and clinical characteristics and about the coronary unit. Data were analyzed through non parametrical statistics, using Mann-Whitney, Kruskal-Wallis and Spearman's correlation test. A 0.05 significance level was adopted. Greater stress was found among younger female patients who did not receive psychotherapeutic medication, including the presence of more than two pieces of equipment and no earlier hospitalization at this kind of intensive therapy unit.
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Marosti CA, Dantas RAS. Avaliação dos pacientes sobre os estressores em uma unidade coronariana. ACTA PAUL ENFERM 2006. [DOI: 10.1590/s0103-21002006000200010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: identificar os fatores geradores de estresse para pacientes internados em uma Unidade Coronariana. MÉTODOS: os dados foram coletados através de entrevista com 43 pacientes. Para a avaliação dos estressores foi utilizada uma escala tipo Likert de 4 pontos que avaliou a intensidade do estresse para 42 possíveis estressores, variando de 1 (não estressante) a 4 (muito estressante). RESULTADOS: no geral, a média obtida para os itens foi 1,71, caracterizando-os entre não estressantes e pouco estressantes na percepção dos pacientes. Os fatores mais estressantes foram: ter dor, não conseguir dormir, sentir falta do marido/esposa, ver a família por apenas alguns minutos e não poder mexer os braços. CONCLUSÃO: esses resultados podem auxiliar no planejamento da assistência de enfermagem.
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Biancofiore G, Bindi ML, Romanelli AM, Urbani L, Mosca F, Filipponi F. Stress-inducing factors in ICUs: what liver transplant recipients experience and what caregivers perceive. Liver Transpl 2005; 11:967-72. [PMID: 16035084 DOI: 10.1002/lt.20515] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
The aim of this study was to compare a number of potentially stress-generating factors related to an intensive care unit (ICU) stay from the points of view of patients undergoing liver transplantation or elective major abdominal surgery and their caregivers in order to identify differences and similarities that may help to optimize patient care. The ICU Environmental Stressor Scale questionnaire was administered to 104 liver transplant recipients, 103 major abdominal surgery patients, 35 nurses and 21 physicians. The ICU staff were asked to complete the questionnaire on the basis of their perception of patient stressors. Both patient groups identified Being unable to sleep, Being in pain, Having tubes in nose/mouth, Missing husband/wife, and Seeing family and friends only a few minutes a day as the major stressors; the healthcare providers correctly identified the most stressing factors for the patients, but gave them higher scores. The mean scores were 71.9 +/- 18.7 for the transplant recipients, 66.3 +/- 20.9 for the patients undergoing elective major abdominal surgery, 99.7 +/- 19.2 for the nurses, and 92.7 +/- 16.1 for the physicians (P < 0.001). The qualitative evaluations of potentially stress-inducing ICU situations were substantially the same in the 2 patient groups, but the transplant recipients seemed to feel them more acutely. Although the caregivers identified the most discomforting situations, they overestimated the degree of stress they cause. The staff of each ICU should therefore seek to understand and reduce (even by means of simple interventions) the particular causes of psychophysical stress felt by their patients.
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Affiliation(s)
- Gianni Biancofiore
- Postsurgical and Transplant I.C.U., Azienda Ospedaliera Universitaria Pisana, Ospedale di Cisanello, Pisa, Italy.
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Johnson P. Reclaiming the everyday world: how long-term ventilated patients in critical care seek to gain aspects of power and control over their environment. Intensive Crit Care Nurs 2004; 20:190-9. [PMID: 15288872 DOI: 10.1016/j.iccn.2004.05.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2004] [Indexed: 10/26/2022]
Abstract
Critical care nurses are increasingly seeking to base patient care on evidence derived from research studies. The purpose of this study was to explore the meanings former patients attributed to being on long-term mechanical ventilation in a critical care unit (CCU) in Australia. Using Heideggerian phenomenology, unstructured interviews were undertaken with nine participants. Data were analysed thematically using the method developed by van Manen. Thematic analysis revealed four major themes. This article presents the findings from the theme titled: Reclaiming the everyday world, which describes how the study participants gained comfort from the presence of nurses and their families, sought control over their treatments, and questioned and interpreted the environment, in order to reclaim self. The study highlighted the central role of nurses in patient care, and served as a basis for a number of recommendations, which include recognising the significant role of nurses and family in patient care, and being aware that patients may want more control over their environment and instigate ways to facilitate this. Further research is warranted to examine CCU patients' perceived level of control and power, and to investigate the extent and type of involvement CCU patients would like to have in their care.
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Affiliation(s)
- Patricia Johnson
- Critical Care Programs, Faculty of Nursing and Health, Griffith University Gold Coast, PMB 50 Gold Coast Mail Centre, Qld 9726, Australia.
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Carno MA, Hoffman LA, Henker R, Carcillo J, Sanders MH. Sleep monitoring in children during neuromuscular blockade in the pediatric intensive care unit: a pilot study. Pediatr Crit Care Med 2004; 5:224-9. [PMID: 15115558 DOI: 10.1097/01.pcc.0000124024.92280.f9] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Sleep is an important physiologic process that is known to be disrupted in the intensive care unit. Nevertheless, there is little information on how intensive care unit admission affects sleep in children. Because laryngotracheoplasty is elective but entails 5-7 days of neuromuscular blockade following surgery, children undergoing this procedure present a unique opportunity to analyze sleep during neuromuscular blockade apart from confounding variables resulting from critical illness. OBJECTIVE To determine the feasibility of using polysomnography to assess sleep patterns in children during neuromuscular blockade. METHODS Polysomnography recordings were obtained continuously for 4 days (96 hrs) in two children following laryngotracheoplasty. Medication administration (neuromuscular blockades, sedatives) and time of suctioning were also recorded. RESULTS Both subjects had documented sleep. However, the proportion of time in each stage was markedly different from developmental norms, and a greater proportion of sleep occurred during the day. Furthermore, there was substantial day-night and day-to-day variability. Some rebound of consolidated sleep appeared by day 4. Sedative use varied considerably. However, neither bolus sedation administration nor endotracheal suctioning appeared to affect sleep. Few monitoring difficulties were encountered. CONCLUSIONS Sleep can be monitored with minimal difficulty in children undergoing neuromuscular blockade in the pediatric intensive care unit. Sleep occurred throughout the day, and there was considerable fragmentation. To fully assess sleep in the intensive care unit, monitoring needs to be continuous over several days, rather than only at night or for < or =24 hrs. Further research is needed in the area to determine typical sleep patterns in children undergoing neuromuscular blockade.
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Gois CFL, Dantas RAS. [Stressors in care at a thoracic surgery postoperative unit: nursing evaluation]. Rev Lat Am Enfermagem 2004; 12:22-7. [PMID: 15122401 DOI: 10.1590/s0104-11692004000100004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The aim of this descriptive study was to determine what events are perceived as stressful to patients in the thoracic surgery postoperative unit, according to nursing evaluation. Data were collected at two hospitals, where the intensive care nursing team members completed the questionnaire. A 4-point Likert scale was used to evaluate 42 possible stressors. The sample consisted of 58 nursing professionals. The average duration of their professional activities at the intensive care unit was 5.9 years. The average stressfulness score of the items was 2.97 (from little stressful to stressful). The most important stressors were: having pain, having tubes in nose and/or mouth, being tied down by tubes and not being able to sleep. We concluded that, according to nursing evaluation, the main stressors for patients are associated with the surgical procedure.
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So HM, Chan DSK. Perception of stressors by patients and nurses of critical care units in Hong Kong. Int J Nurs Stud 2004; 41:77-84. [PMID: 14670397 DOI: 10.1016/s0020-7489(03)00082-8] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The frightening experience in critical care units, whether it be associated with the disease process or related to the critical care environment, has an important impact on clients' recovery and rehabilitation. A comparative descriptive study was conducted in the critical units of two major hospitals in Hong Kong to assess the perception of stressors by patients and nurses. A Chinese version of the Intensive Care Unit Environmental Stressor Scale (ICUESS) was used. Significant similarities and differences were noted between patients and nurses on their perceptions of stressors in the critical care environment. Critical care nurses, apart from maintaining their efforts to minimize the negative effects of the stressful critical care environment, needed to equally focus on the patients' psychological needs through measures in re-establishing patients' self-control and minimizing the emotional stress.
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Affiliation(s)
- Hang Mui So
- Intensive Care Unit, Department of Anasethesia, Pamela Youde Nethersole Eastern Hospital, 3 Lok Man Road, Chai Wan, Hong Kong.
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Piotrowski MM, Paterson C, Mitchinson A, Kim HM, Kirsh M, Hinshaw DB. Massage as adjuvant therapy in the management of acute postoperative pain: a preliminary study in men. J Am Coll Surg 2003; 197:1037-46. [PMID: 14644293 DOI: 10.1016/j.jamcollsurg.2003.07.020] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Opioid analgesia alone may not fully relieve all aspects of acute postoperative pain. Complementary medicine techniques used as adjuvant therapies have the potential to improve pain management and palliate postoperative distress. STUDY DESIGN This prospective randomized clinical trial compared pain relief after major operations in 202 patients who received one of three nursing interventions: massage, focused attention, or routine care. Interventions were performed twice daily starting 24 hours after the operation through postoperative day 7. Perceived pain was measured each morning. RESULTS The rate of decline in the unpleasantness of postoperative pain was accelerated by massage (p = 0.05). Massage also accelerated the rate of decline in the intensity of postoperative pain but this effect was not statistically significant. Use of opioid analgesics was not altered significantly by the interventions. CONCLUSIONS Massage may be a useful adjuvant therapy for the management of acute postoperative pain. Its greatest effect appears to be on the affective component (ie, unpleasantness) of the pain.
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Affiliation(s)
- Marcia M Piotrowski
- Performance Improvement Department, VA Ann Arbor Health Care System, MI 48105, USA
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Mitchell ML, Courtney M, Coyer F. Understanding uncertainty and minimizing families' anxiety at the time of transfer from intensive care. Nurs Health Sci 2003; 5:207-17. [PMID: 12877722 DOI: 10.1046/j.1442-2018.2003.00155.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
When general ward registered nurses (RN) receive patients from an intensive care unit (ICU) they report that much of their time in the initial phases revolves around meeting family needs (Farvis, 2002). Families experience anxiety when leaving the security of the close monitoring seen in ICU (Leith, 1999) and their anxiety reduces their ability to play a key role in the patient's recovery (McShane, 1991; Leske, 1992) as it can impair their decision-making (Cagan, 1988; Halm et al., 1993). By reducing a family's anxiety, they may be more able to cope with the necessary transition to a general ward and support the patient's recovery. A literature search from 1990 onwards was performed within the CINAHL, Medline and Cochrane databases using the key words: intensive care, family, General System Theory, uncertainty, anxiety and transfer. Further articles were retrieved from citation references from the Web of Science or through the reference lists of retrieved literature. Library catalogues were searched using the same key words for books and book chapters. von Bertalanffy's General System Theory provides a framework for understanding the importance of family in a critical illness situation. Critical illness permits little or no time to adapt, thus reducing the family's ability to cope with the situation. Transfer out of ICU is a significant anxiety-producing event for families. Uncertainty in illness is reported in other illness situations to reduce family's adaptation to illness events, but has not been researched with an ICU cohort of families. Seven out of the top 10 needs of ICU families are information needs, highlighting the importance of communication regarding progress and future plans. Nurses require an increased awareness that transfer anxiety exists for families and to be knowledgeable about ways to reduce its occurrence. Research is required to evaluate the efficacy of interventions to reduce anxiety for families and examine the level of uncertainty in illness in this cohort.
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Affiliation(s)
- Marion L Mitchell
- School of Nursing, Griffith University, Logan Campus, Meadowbrook, Queensland 4131, Australia.
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Abstract
Assessment and management of patients’ pain across practice settings have recently received the increased attention of providers, patients, patients’ families, and regulatory agencies. Scientific advances in understanding pain mechanisms, multidimensional methods of pain assessment, and analgesic pharmacology have aided in the improvement of pain management practices. However, pain assessment and management for critical care patients, especially those with communication barriers, continue to present challenges to clinicians and researchers. The state of nursing science of pain in critically ill patients, including development and testing of pain assessment methods and clinical trials of pharmacological interventions, is described. Special emphasis is placed on results from the Thunder Project II, a major multisite investigation of procedural pain.
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Shi SF, Munjas BA, Wan TTH, Cowling WR, Grap MJ, Wang BBL. The effects of preparatory sensory information on ICU patients. J Med Syst 2003; 27:191-204. [PMID: 12617360 DOI: 10.1023/a:1021869112673] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Preparatory sensory information (PSI) has been found to have significant effects in reducing distress, tension, restlessness, negative moods, and anxiety, and also in reducing length of postoperative hospitalization during various threatening medical events, but no evidence has demonstrated the effect of PSI on a patient during ICU hospitalization. On the basis of Lazarus' theory, a structural equation model was developed to examine the role of the nursing intervention, PSI, as a significant factor influencing patients' processes of cognitive appraisals and coping, adaptational responses, and patient care outcomes during ICU hospitalization. The analytical model examined the net effect of PSI on outcomes, controlling for the effects of mastery, interpersonal trust, social support, socioeconomic status, severity of illness, age, and gender. A quasi-experiment was executed in four large acute care hospitals. Data were collected from 41 subjects in the control group and from 42 in the treatment group receiving PSI before ICU admission. Structural equation modeling was employed to test the proposed analytic model. The initial tests of model fit indicate that the original model did not fit the data well with GFI = 0.85, AGFI = 0.76, RMSEA = 0.059, p_close = 0.28, and critical N = 78. A revised model was developed, and the fit indices suggested an adequate fit with GFI = 0.90, AGFI = 0.84, RMSEA = 0.00, p_close = 0.89, and critical N = 109. These findings provide empirical support for Lazarus' theory on stress, appraisal, and coping. The findings also verify the beneficial effects of the nursing intervention of PSI on ICU patients.
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Affiliation(s)
- Shu-Feng Shi
- School of Nursing. National Defense Medical Center, Taipei, Taiwan
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Affiliation(s)
- Julie A. Stanik-Hutt
- Julie Stanik-Hutt is an acute care nurse practitioner in the pulmonary and critical care division, department of medicine, at the Johns Hopkins University School of Medicine, Baltimore, Md
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